Cystic fibrosis, a genetic disorder in children and young adults, is a multisystemic disease that mainly affects the lungs. Advances and improvements in the diagnosis and management of this condition have led to increased overall and symptom-free survival in cystic fibrosis patients. This book examines recent advances in the field and presents an evidence-based approach to the management of cystic fibrosis.

Cystic fibrosis (CF) is one of the most common fatal hereditary diseases. The discovery of the cystic fibrosis transmembrane conductance regulator (CFTR) gene 25 years ago set the stage for unraveling the pathogenesis of CF lung disease, continuous refinement of symptomatic treatments and the development of mutation-specific therapies, which are now becoming available for a subgroup of patients. This ERS Monograph provides an update on all aspects of CF lung disease, from infancy to adulthood, including current concepts on disease process, improvements in early diagnosis and monitoring, therapeutic approaches, and patient care. The book highlights important recent developments and discusses the next steps that will be required for further improvement of the life expectancy and quality of life of CF patients. It will be an essential reference for basic and clinical scientists and all members of the CF team.

This book provides a comprehensive overview of the multisystem disease, cystic fibrosis, for both pediatric and adult patients. Written by experts in the field, the text outlines the progressive nature of CF as well as the impact of this autosomal recessive disease on the respiratory, gastrointestinal, endocrine, rheumatologic, and renal systems, as well as the patient’s mental health. The book begins with a chapter describing the history of cystic fibrosis and how the face of this life-shortening disease has changed over the past several decades. The following chapters elucidate the pathophysiology of how cystic fibrosis impacts each organ system. Current management and therapeutics are detailed with step-by-step guidelines for clinicians. This book is unique in that it highlights the entire person, not just the respiratory system, with detailed inclusion of the patient perspectives throughout, informing practice standards and considerations. This is an ideal guide for pediatric and adult physicians who care for patients with cystic fibrosis, as well as respiratory therapists, physical therapists, nurses, nutritionists, and pharmacists who care for these patients.

Summary of Genes. Thirty years ago, the gene responsible for cystic fibrosis (CF), a recessive genetic disease caused by mutations in the cystic fibrosis transmembrane conductance regulator gene, was identified. This progress has considerably changed our understanding of the pathophysiology of CF and has paved the way for the development of novel and specific therapies for the disease. The CFTR gene contains 27 exons and is characterized by a frequent three base pair deletion of the p.Phe508del. As a result of collaborative work, today more than 2000 mutations have been reported in the gene, and their impact on protein function is now more evident and useful in designing new strategies to correct the gene defect. The field of gene therapy, as illustrated by Ziying Yan in this book, has worked on identifying an efficient vector system for the delivery of the wild-type CFTR gene to the lung. At the same time, animal models have been developed in mice, rats, rabbits, zebrafish, ferrets, and pigs to establish the efficacity of gene delivery. These animals are also of the utmost importance in testing new molecules as modulators or correctors to improve the CFTR lung function. During the last three decades, the epidemiology of CF has dramatically changed, as today cystic fibrosis is now a chronic adult pulmonary disease.

Nutritional therapies have been key early interventions, and remain central to the well-being and survival of patients with cystic fibrosis. The nature of the disease causes significant alterations in a patient’s ability to process and assimilate nutrients. Furthermore, many factors contribute to higher metabolic demands throughout a patient’s life. In combination, maldigestion, malabsorption, and increased metabolic demands pose a high hurdle for the patient to overcome in order to maintain optimal nutritional status. Nutrition in Cystic Fibrosis: A Guide for Clinicians is an excellent resource for physicians, nurses and dietitians who deliver care for patients with cystic fibrosis. The book provides an introduction to cystic fibrosis and nutritional assessments. It will also serve as a comprehensive guide to the nutritional monitoring and management of patients with cystic fibrosis including special populations within cystic fibrosis that require additional considerations. The chapters are written by experts in their fields and include the most up to date scientific and clinical information. Nutrition in Cystic Fibrosis: A Guide for Clinicians targets pediatric and adult pulmonologists and gastroenterologists, residents and fellows, internists, pediatricians, nurses, dietitians and general practitioners who treat patients with cystic fibrosis.

Cystic fibrosis is a disease that affects the entire body. It tends to be thought of as primarily a pulmonary disease since pulmonary decline is the main factor in early mortality. Because of the multi-system nature of the disease, a better understanding of cystic fibrosis expands the family physician's understanding of subjects ranging from genetics to pulmonary function to nutrition to colon transport to hydration to electrolyte management. The primary care philosophy is unique in that it always considers how a narrow problem can affect an individual globally. Cystic Fibrosis care can often feel fractured to patients as they are sent to multiple specialists to deal with problems outside of the comfort level of a prior or current specialist. With a broad medical philosophy, care is more inclusive as clinicians can manage topics such as diabetes and preventive care without multiple referrals and additional appointments. Family physicians are well-positioned and well-qualified to competently meet many of the care needs of those with cystic fibrosis. This book is edited by a family medicine physician who has specialist level experience with the disease. It opens with a background on cystic fibrosis foundations and centers to familiarize the reader. The next chapter gives a basic overview of the disease. Each of the subsequent chapters provide a comprehensive look at how cystic fibrosis affects other areas of the body that the primary care physician should be familiar with. Major components of cystic fibrosis such as physiology, spirometry, inflammation, airway clearance, chronic infection, cystic fibrosis related diabetes and pancreatic insufficiency, among others, are thoroughly explained. Written by experts in the field, Cystic Fibrosis in Primary Care appeals to all family physicians as well as specialists, residents, medical students physician assistants and nurse practitioners alike.

In this issue of Clinics in Chest Medicine, guest editors Drs. Clemente J. Britto and Jennifer L. Taylor-Cousar bring their considerable expertise to Advances in Cystic Fibrosis. Top experts in the field cover key topics such as genetics of cystic fibrosis (CF): clinical implications; innate and adaptive immunity in CF; novel applications of biomarkers and personalized medicine to define the spectrum of CF; emerging approaches to understand CF pathogenesis; and more. - Contains 18 relevant, practice-oriented topics including novel approaches to multidrug resistant infections in CF; clinical outcomes of highly-effective modulator therapy; nontuberculous mycobacterial infections in CF; management of mental health in CF; sexual and reproductive health in CF; nutritional management in CF; transitions of care in CF; and more. - Provides in-depth clinical reviews on advances in cystic fibrosis, offering actionable insights for clinical practice. - Presents the latest information on this timely, focused topic under the leadership of experienced editors in the field. Authors synthesize and distill the latest research and practice guidelines to create clinically significant, topic-based reviews.